Waiver Form Signature

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Waiver

MAD APPLE CROSSFIT WAIVER & RELEASE

3630 Illinois Road Suite 100., Fort Wayne, IN 46804 ▪ (260) 348-0635

I willingly assume full responsibility for any and all risks that I am exposing myself to as a result of my participation in Mad Apple CrossFit programs/classes or open gym and accept full responsibility for any injury or death that may result from participation in any activity, class, or physical fitness program. I hereby certify that I know of no medical problems that would increase my risk of illness and injury as a result of participation in a fitness program designed by Mad Apple CrossFit. I acknowledge that Mad Apple CrossFit does not require a medical exam or medical certification of my physical ability as a condition to the use of Mad Apple CrossFit. With my full understanding of the above information, I agree to assume any and all risk associated with my participation in Mad Apple CrossFit programs and classes.

By signing this document, I acknowledge that I have voluntarily chosen to participate in a program of physical exercise. I fully understand that (a) CrossFit and personal training activities involve risks and dangers and that the strenuous nature of these activities creates the potential for unusual, but possible physiological results including, but not limited to, serious bodily injury, abnormal blood pressure, rhabdomyolysis, fainting, heart attack, paralysis, permanent disability, or death; (b) these risks and dangers may be caused by my own actions, or inactions, the actions or inactions of others participating in the activity, the condition in which the activity takes place, or the negligence of the RELEASEES named below; (c) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks to my health, my injury or death and all responsibility for losses, costs, and damages incurred as a result of my participation in the activity.

This Waiver & Release of all liability includes, without limitation, injuries which may result by (a) my use of the facility or an offsite location or its improper maintenance, (b) my use of any indoor or outdoor exercise equipment which may malfunction or break, (c) Mad Apple CrossFit’s improper maintenance of any indoor or outdoor exercise equipment, (d) negligent instruction or supervision, (e) negligent hiring or negligent retention of any employees, (f) loss of consortium, (g) my slipping or falling while in the facility or surrounding premises or (h) first aid, emergency treatment or any other services which are negligently rendered or failed to be rendered by released parties, emergency personnel or Good Samaritans, or Mad Apple CrossFit’s negligently preventing a Good Samaritan from rendering first aid. Employees of Mad Apple CrossFit may not file, or try to file for Workmen’s Compensation for any injuries that may occur using the center. It is a separate entity that should be utilized on your own free time and is not to be used during your employment hours, and shall not constitute compensable work time.

Rules and Regulations: I agree to follow all rules and regulations now in force or in the future adopted by Mad Apple CrossFit, including but not limited to hours of operation, use of equipment, services, premises, personal hygiene and attire. Mad Apple CrossFit reserves the right to revoke my membership, without refund, if I fail to follow any rules or regulations, for reasons of nuisance, disturbance of others, moral turpitude or fraud, or if Mad Apple CrossFit determines that my actions may endanger myself or others, or for any other reason at its complete and unilateral direction.

Client’s Responsibility: I acknowledge that it is my responsibility to obtain a physical exam before using the Mad Apple CrossFit. It is advised to obtain a physical exam with your physician prior to the start of any exercise program. You agree that you will not use the facility with any medical condition, including open or seeping wounds, infections, maladies, or inability to maintain personal hygiene, if such condition poses a direct threat to the health or safety of yourself or others. We reserve the right to deny facility access due to the above-mentioned conditions.

Photo/Video Release: I hereby grant Mad Apple CrossFit permission to use my photograph/video image in any and all publications for Mad Apple CrossFit, including websites entries, without payment or any other consideration in perpetuity. I hereby authorize Mad Apple CrossFit to edit, alter, copy, exhibit, publish, or distribute all photos and images. I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my photo appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph or video images.

Release and Indemnification: In consideration of the above mentioned risks and hazards and in consideration of the fact that I am willingly and voluntarily participating in the activities available at Mad Apple CrossFit, I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless Mad Apple CrossFit, Faroo Enterprises, LLC, any respective administrators, directors, agents, officers, volunteers, shareholders, members, and employees, other participants, any sponsors, advertisers, and if applicable, owners and lessors of premises on which the Activity takes place (each considered one of the "Releasees” herein) from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the "Releasees” or otherwise, including negligent rescue operations, death or injury to me, and further agree that if, despite this release, I, or anyone on my behalf makes claim against any of the Releasees named above, I will indemnify, save and hold harmless each of the releases from any litigation expenses, attorney fees, loss liability, damage or costs that I may incur as the result of any such claim. Additionally, I understand that I will be financially responsible if I purposely misuse or damage any fitness equipment or any other amenities provided by Mad Apple CrossFit.

This Agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, and transferees. If any portion of this Agreement is held invalid, I agree that the remainder of the Agreement shall remain in full legal force and effect.

If I am signing on behalf of a minor child, I also give full permission for any person connected with Mad Apple CrossFit to administer first aid deemed necessary and in case of serious injury or illness, I give permission to call for medical and/or surgical care for the child and to transport the child to a medical facility deemed necessary for the well-being of the child. I further agree to reimburse Mad Apple CrossFit for any expense or cost it has incurred in rendering any first aid and/or procuring any medical care for that child.

I have fully read and understand the foregoing assumption of risk, and release of liability and I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights and this release is intended to be as broad as permitted under the laws of the state of Indiana.

I have carefully read this agreement and fully understand it contents. I am aware that this is a release and waiver of liability and sign it knowingly, voluntarily, and of my own free will.


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